Utsuki Satoshi, Oka Hidehiro, Sato Sumito, Shimizu Satoru, Suzuki Sachio, Tanizaki Yoshinori, Kondo Koji, Miyajima Yoshiteru, Fujii Kiyotaka
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
Neurol Med Chir (Tokyo). 2007 May;47(5):210-3; discussion 213-4. doi: 10.2176/nmc.47.210.
Intraoperative 5-aminolevulinic acid (5-ALA)-induced fluorescence guidance for resection of malignant brain tumors was correlated with histological examination to investigate false positive findings in 42 patients with malignant glioma and six patients with metastatic brain tumor. Patients received a single 1 g oral dose of 5-ALA 2 hours before surgery. The tumor site was illuminated with a laser with a peak wavelength of 405 +/- 1 nm and output of 40 mW. Samples with strong fluorescence were obtained from the tumor bulk and samples with weak fluorescence from the tumor cavity. Fluorescence was observed in 36 of the 42 malignant gliomas and four of the six metastatic brain tumors. No tumor cells were found in fluorescent samples from six of the 36 malignant gliomas and all four metastatic brain tumors. Five of the six malignant gliomas were recurrent cases. Fluorescence was found in areas of peritumoral edema or inflammatory cell and reactive astrocyte infiltration. Intraoperative 5-ALA-induced fluorescence guidance is useful for the resection of initial malignant glioma since false positive results are rare, but only non-eloquent weak positive areas should be resected. In contrast, all weak positive areas of recurrent malignant gliomas must be resected. Weak positive areas of the peritumoral edema surrounding metastatic brain tumors should be removed carefully as false positive results are common.
术中5-氨基乙酰丙酸（5-ALA）诱导的荧光引导用于恶性脑肿瘤切除术，并与组织学检查相关联，以研究42例恶性胶质瘤患者和6例脑转移瘤患者中的假阳性结果。患者在手术前2小时口服1 g单剂量的5-ALA。用峰值波长为405±1 nm、输出功率为40 mW的激光照射肿瘤部位。从肿瘤主体获取强荧光样本，从肿瘤腔获取弱荧光样本。42例恶性胶质瘤中有36例以及6例脑转移瘤中有4例观察到荧光。36例恶性胶质瘤中的6例以及所有4例脑转移瘤的荧光样本中未发现肿瘤细胞。6例恶性胶质瘤中有5例为复发病例。在肿瘤周围水肿区域或炎性细胞及反应性星形胶质细胞浸润区域发现荧光。术中5-ALA诱导的荧光引导对原发性恶性胶质瘤的切除有用，因为假阳性结果罕见，但仅应切除无功能的弱阳性区域。相比之下，复发性恶性胶质瘤的所有弱阳性区域都必须切除。由于假阳性结果常见，应小心切除脑转移瘤周围水肿的弱阳性区域。
